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Thrombectomy versus Medical Management for Pediatric Acute Ischemic Stroke Due to Isolated M2 Occlusion: A
Peter B Sporns1,2,3, Kartik D Bhatia4, Prakash Muthusami5
1Department of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland.
Objective:
Endovascular thrombectomy (EVT) is increasingly used for pediatric large vessel occlusion (LVO) stroke, however, its role in isolated M2 occlusions remains underexplored. This study compared clinical outcomes in children with isolated M2 occlusion treated with EVT versus best medical therapy (BMT).
Methods:
This multicenter cohort study pooled data from 4 pediatric stroke registries (Save ChildS, KidClot, Pediatric LVO Study, and Save ChildS Pro). Children ages 28 days-17 years with isolated M2 occlusion presenting within 24 hours of last seen well were included. Primary outcome was the pediatric modified Rankin scale (ped-mRS) at 3 to 6 months. Secondary outcomes included changes in Pediatric National Institutes of Health Stroke Scale (PedNIHSS), Pediatric Stroke Outcome Measure (PSOM), and safety endpoints.
Results:
Forty patients were included, of whom 20 were treated with EVT (median age, 12 years; interquartile range [IQR], 6-15; 40% female) and 20 with BMT only (10 years; IQR, 5-14; 50% female). Baseline demographics were similar. EVT patients showed superior outcomes: median ped-mRS at 3 to 6 months was 1 versus 2 (p = 0.015). EVT resulted in greater PedNIHSS reduction from admission to day 7 (-9 vs -1, p < 0.001) and lower PSOM at 3 to 6 months (0.5 vs 2.5, p = 0.009). This benefit persisted at 24 months with a median ped-mRS of 1 (IQR, 0-2) in the EVT group and 2 (IQR, 1-3) in the BMT group (p = 0.012). One symptomatic intracranial hemorrhage occurred in the BMT group, and no deaths or access-site complications were reported.
Interpretation:
In children with isolated M2 occlusion, EVT was associated with better functional outcomes and neurological recovery than medical therapy alone, with an acceptable safety profile. ANN NEUROL 2026;99:684-691.
Insights
Endovascular thrombectomy (EVT) in children with isolated M2 large vessel occlusion stroke led to better functional outcomes compared to best medical therapy (BMT). EVT demonstrated improved neurological recovery and a favorable safety profile in pediatric stroke patients.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Endovascular thrombectomy (EVT) is increasingly utilized for pediatric large vessel occlusion (LVO) stroke.
- The efficacy of EVT in isolated M2 occlusions in children is not well-established.
Purpose of the Study:
- To compare clinical outcomes between EVT and best medical therapy (BMT) in children with isolated M2 occlusion stroke.
- To evaluate the safety and effectiveness of EVT in this specific pediatric population.
Main Methods:
- A multicenter cohort study pooling data from four pediatric stroke registries.
- Included children aged 28 days to 17 years with isolated M2 occlusion within 24 hours of last seen well.
- Primary outcome: pediatric modified Rankin scale (ped-mRS) at 3-6 months; secondary outcomes: PedNIHSS, PSOM, and safety endpoints.
Main Results:
- Forty patients (20 EVT, 20 BMT) were analyzed; baseline demographics were similar.
- EVT group showed superior outcomes: lower median ped-mRS (1 vs 2 at 3-6 months, p=0.015) and sustained benefit at 24 months.
- EVT led to greater PedNIHSS reduction and lower PSOM scores, with an acceptable safety profile (no deaths or access complications).
Conclusions:
- EVT is associated with improved functional outcomes and neurological recovery in children with isolated M2 occlusion stroke compared to BMT alone.
- EVT presents an acceptable safety profile for treating pediatric M2 LVO stroke.
- This study supports EVT as a viable treatment option for selected pediatric stroke cases.
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